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I was called on a Saturday afternoon by a Sarah, the mother of a 2 year old girl, Julie, whom she had noticed running a fever that day. The child had some nasal congestion and a slight cough for a couple days prior to the call, but even though her appetite was down she was drinking well. She also indicated that Julie was sleeping well. Sarah’s concern was that the Julie’s fever was a sign that she was getting sicker and wanted to know what she could do to make the fever go away.

As a pediatrician, this issue comes up many times a week and a common question is, “At what temperature should I take my child to the emergency room?” Parents are concerned that a fever is going to progress to the point where a child will become dehydrated, have a seizure and brain damage or that it is always a sign of a potentially life threatening infection. In talking with parents about fever, I try to help them understand that it is the body’s natural way of fighting viruses and bacteria. The fever not only stimulates the immune system, but the viruses and bacteria have difficult time growing and reproducing when a person’s temperature is elevated.

While it is true that in some children fevers can lead to seizure or dehydration, they will not lead to brain damage or death. Hyperthermia is different than fever in that for some reason (drugs, exercise without proper cooling, confinement in a hot area, thyroid problems, brain injury, etc.) the body cannot maintain a stable body temperature; in these cases, more intensive medical treatment is needed.

To put fevers into perspective:

• 100 to 102 F (37.8 to 39 C) - Low-grade fever which is beneficial. Try to keep the fever here.
• 102 to 104 F (39 to 40 C) - Moderate-grade fever which is also beneficial.
• Over 104 F (40 C) - High fever which is harmless but may cause discomfort.
• Over 105 F (40.6 C) - High fever which may indicate higher risk of bacterial infection.
• Over 108 F (42 C) - Serious hyperthermia which is harmful and medical attention is necessary.

Upon further questioning, I learned that Sarah had felt Julie’s forehead and that was how she had noted the fever. I asked her to find her thermometer and actually take Julie’s temperature while explaining to her that checking the forehead is only accurate about 22% of the time. Sarah indicated that Julie’s temperature under the arm was 99.8 under the arm for which we adjusted up one degree to 100.8. If she had taken Julie’s temperature orally or rectally, it would not have been necessary to make an adjustment.

In this case, I instructed Sarah that Julie was most likely running the fever to fight off the cold virus she had picked up. As long as Julie was comfortable, drinking and active, it was not necessary to treat the fever. If Julie’s fever was causing her discomfort, then Sarah was instructed to give acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to make her more comfortable. Sarah was also instructed that if Julie’s symptoms changed, lethargy, irritability, sore throat, ear or abdominal pain, painful or decreased (less than 4 times in the previous 24 hours) urination, or difficult breathing, etc., she was to call back for or seek further assistance. As expected, the fever resolved 2 days later, Julie recovered from her cold, and now her mother is better prepared for her next illness. And, as all parents and physicians know, there definitely will be a next one!

Michelle M. Irons, MD
Academy of Medicine of Toledo and Lucas County